A group of ACS leaders convened a decade ago to discuss the training of general surgeons in the US. Two issues were front and center at that meeting: The large majority of those finishing general surgery residencies chose to pursue specialty fellowships rather than enter general surgery practice. There was no postgraduate program in general surgery available that provided advanced clinical experience to those who desired further clinical training as well as mentorship in nonclinical aspects of practice such as leadership, practice management, billing, and medicolegal matters.
To begin addressing these issues, a steering committee developed the ACS Transition to Practice Program. In 2018, this program was expanded and rebranded as the Mastery in General Surgery Program, underscoring its aim to provide a mastery of the elements of general surgery practice. Since its inception, 46 sites have participated nationwide, and more than 110 surgeons have completed the program. The 10-year anniversary of the program offers an opportunity to reflect upon and evaluate the current and future states of the program.
Unfortunately, the supply of general surgeons within the US continues to be a problem. While there is debate as to whether this is an overall workforce shortage or a maldistribution, the outcome is the same. For many Americans, access to general surgery care is not available in or near their communities.
Published statistics vary, but this trend is expected to worsen over the next couple of decades, and conservative estimates put the deficit of general surgeons at more than 19,000 by the year 2030.1 This shortage disproportionately affects rural and other underserved areas where general surgeons are vital to the survival of smaller hospitals. For more information on the supply of surgeons, read the Bulletin article, “Physician Workforce Data Suggest Epochal Change,” in the April 2024 issue.
At the same time, more than 80% of graduating general surgery residents continue to seek specialty fellowship training just as they did at the inception of the program in 2014. Some of these trainees may go on to practice general surgery but most will seek practice largely confined to the specialty in which they completed their fellowship.
Interest in the specialty remains the most common driver in seeking fellowships but 55% note lack of confidence in performing cases independently as playing a role in choosing fellowship training.2 Based on available data, we are training specialists, but failing to train general surgeons who are desperately needed.
Addressing the shortage of general surgeons is a complex task that requires a multipronged approach, including advocacy and legislative solutions, in which the College is actively engaged and supports. Additional efforts are aimed at mitigating graduate medical education issues, addressing problems related to student loans, and highlighting the surgical needs of underserved populations and areas.
Future Enhancements to the Program
The Mastery in General Surgery Program is positioned to play a vital role in building a solution to this shortage. The issues that existed during the creation of the program, such as graduates seeking specialty training rather than entering general surgical practice, still exist, and, in some cases, have worsened over the intervening decade. Reflecting on these ongoing trends and evaluating achievements over the past 10 years, the program steering committee has developed new initiatives.
Upcoming improvements intended to enhance the program include developing a repository of resources, implementing a more structured accreditation program, and increasing the number of accredited programs in the US.
There is a wealth of educational resources available for those entering the practice of general surgery. Some are easy to find, and some are more difficult. Moving forward, one of the important additions to the program will be a centralized, curated archive of resources for education on clinical topics as well as nonclinical areas such as management/leadership skills, billing practices, contract negotiations, and other relevant areas.
Program administrators have developed a more structured accreditation program for sites to ensure the availability of a standard set of resources and experiences. While there will not be a prescriptive curriculum, the accreditation standards will provide a solid, dynamic framework of concepts within which associates will learn. Central components of this framework will be autonomy of practice with mentorship and flexibility of training plans to allow for specific associate goals. For example, associates may choose to emphasize advanced endoscopy, robotics, critical care, or rural practice contingent upon the resources of the program site.
The Value of Mentorship
Ongoing mentorship after surgical residency is vital in helping new graduates successfully navigate the steep learning curve of clinical and professional development. Traditionally, this important role has been assumed by senior surgeons. The pressures of current surgical practice, though, have diminished the ability of established practices to fulfill this role.
A few years ago, the program was contacted by a graduate from a general surgery residency who had done quite well and had entered the practice of general surgery after finishing residency. She entered a practice that had agreed to provide her with ongoing guidance as she began to build her practice. Unfortunately, she was unable to find partners willing to discuss clinical ideas or help with challenging cases as everyone was exceptionally busy at several hospitals managing their own practices.
The Mastery in General Surgery Program was a way for her to gain exposure to mentorship and advanced training in the field. After spending a year in the program, she is now working with a group of surgeons and building a thriving practice of her own. Mentorship for those seeking to enter general surgery practice is a central pillar of the program.
With these new cornerstones in place, the Mastery in General Surgery Program is positioned to serve as an important part of the solution to the surgeon workforce shortage and maldistribution of general surgeons throughout the US. The goal is to double the number of sites in the next 5 years. Academic medical centers will play a vital role in this expansion, but key to the growth will be new sites, including community training programs, especially in rural areas, hospital systems, and large private practices.
For information on starting a new site or other questions about the program, email MasteryGS@facs.org, or visit Mastery in General Surgery Program.
